Age, Not MRI T2 Signal Intensity, Predicts Neurological Recovery After Surgery for Cervical Spinal Cord Injury Without Radiographic Evidence of Trauma

Study DesignRetrospective Cohort Study.ObjectivesTo evaluate the prognostic value of preoperative increased signal intensity (ISI) grade on T2-weighted magnetic resonance imaging (MRI) and to identify risk factors associated with poor neurological recovery after surgery in adult cervical spinal cord injury without radiographic evidence of trauma (SCIWORET).MethodsA total of 128 consecutive SCIWORET patients who underwent surgical treatment between January 2016 and June 2023 were retrospectively analyzed. Patients were classified into 3 groups (Grade 0, 1, and 2) according to ISI grade on preoperative MRI. Neurological function was assessed using the Japanese Orthopaedic Association (JOA) score and recovery rate (RR). Multivariate logistic regression analysis identified predictors of poor RR (< 50%), and receiver operating characteristic (ROC) analysis determined the optimal age cutoff for prognosis.ResultsSignal intensity alterations were observed in 111 patients (86.7%). Higher ISI grades correlated with lower preoperative JOA scores (r = -0.303, <i>P</i> < 0.001) but not with postoperative RR (r = -0.067, <i>P</i> = 0.450). Multivariate analysis identified age as the only independent predictor of poor RR (OR = 1.10, 95% CI: 1.04-1.16, <i>P</i> < 0.001). ROC curve analysis yielded an optimal age cutoff of 58.5 years.ConclusionsPreoperative ISI grade reflected the severity of spinal cord injury but did not predict postoperative neurological recovery. Older age (> 58.5 years) independently predicted poorer outcomes, highlighting the importance of integrating patient age into prognostic counseling and individualized surgical decision-making in SCIWORET.